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Heart Disease and Social Security Disability Claims – Part 1
This column will take a look at how the Social Security Administration evaluates disability claims from people who suffer heart disease. The SSA has a set of Listings covering the various types of heart disease. As readers of this column may recall, the SSA uses a set of criteria to determine if a person’s health problems with a particular disease meet the requirements to be granted monthly Disability Insurance Benefits from the SSA. To understand the Listings for heart disease it is useful to look the mechanics of the heart.
The heart is a muscle about the size of your fist. The heart pumps blood throughout the body. The heart itself has four chambers. The top two chambers are called the atria and the lower two chambers are called the ventricles. The heart is designed to receive oxygen depleted blood after it has circulated through the body and to pump that oxygen poor blood through the lungs where it receives oxygen and then back out into the body to carry the oxygen to the body’s cells. Arteries are blood vessels that take blood away from the heart. Veins are blood vessels that bring blood back towards the heart.
The oxygen depleted blood enters the heart through two large veins call the superior vena cava which receives blood from the upper portion of the body and the inferior vena cava which receives blood from the lower portion of the body. These two veins enter the upper right chamber of the heart which is called the right atrium. The right atrium then pumps the blood through the tricuspid valve into the lower right chamber of the heart which is called the right ventricle.
The right ventricle pumps the blood into the pulmonary valve which leads into the pulmonary artery. The word pulmonary means lung which means the pulmonary valve leads into the artery that leads into the lungs.
The blood pumped into the lungs is filled with carbon dioxide which is expelled by the lungs in breathing out. The inhalation portion of breathing loads oxygen back into the blood that is circulating in the lungs. Blood filled with oxygen returns from the lungs to the heart in the pulmonary veins which enter the upper left chamber of the heart which is called the left atrium.
The left atrium pumps the blood with the oxygen in it through the mitral valve into the left ventricle which is the lower left chamber of the heart. The left ventricle is the strongest part of the heart in that it must pump the blood out of the heart with enough pressure to circulate the blood into the rest of the body. The blood leaves the left ventricle through the aortic valve into the aorta. The aorta is the artery that splits into the other arteries that carry the blood with oxygen into the rest of the body.
The heart has two stages in its pumping of blood. The diastole stage is when the heart is relaxed and the systole stage is when the heart is contracting and pumping blood. In the diastole stage the ventricle relaxes and blood enters the heart from the venae cavae and pulmonary veins. The mitral valve and the tricuspid valves open and blood flows from the right and left atria into the ventricles. The next stage systole occurs and the right and left ventricles contract and pump blood into the aorta and pulmonary artery.
Unfortunately the heart does not always work as perfectly as it was designed to do. The heart can suffer a variety of ailments which interfere with its ability to perform its functions. The SSA Listing for Chronic Heart failure directs that disability benefits will be awarded if the worker is diagnosed with chronic heart failure with either of the following:
A. Enlargement of the heart to certain standards ( documented by a chest x-ray or a echocardiogram of the heart) , which result in the inability to carry on physical activity and with symptoms of inadequate cardiac output, lung congestion, systemic congestion or anginal syndrome at rest. Anginal syndrome is recurrent or persistent fatigue, anginal discomfort (chest pain due to not enough oxygen being available to meet the needs of the heart) , dyspnea (shortness of breath), orthopnea ( Breathing is easier in the upright position, commonly in congestive heart failure the person has difficulty in breathing while lying down because their lungs fill with fluid). Or;
B. Enlargement of the heart or ventricle dysfunction, abnormal ventricle wall motion, or left ventricular ejection fraction of 30% of less of normal. Ventricular ejection fraction is amount of blood that passes through the ventricle. In addition the worker must have the inability to perform at a certain level on an exercise test due to symptoms of chronic heart failure due to 3 or more consecutive premature ventricular heart beats, or failure to increase his systolic blood pressure by certain amount or to decrease his systolic blood pressure below the usual resting level. ; or signs of inadequate cerebral perfusion (circulation) such as ataxic gait (unsteadiness on the feet) or mental confusion. And;
The person has marked limitation of physical activity with such symptoms as fatigue, palpitation ( irregular heart beats), dyspnea, or anginal discomfort on ordinary activity, even though the person is comfortable while resting.
Readers should be aware that these listings are guidelines for the SSA and are not the only factors that the SSA uses in evaluating chronic heart failure. If a claimant meets these listings then his claim should be approved without the necessity of having a hearing before an Administrative Law Judge.